Active NPI
Ira Dean Fontenot, P.D.
- Pharmacist
- Collierville, TN
National Provider Identifier
1598034142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12348
- Practice address
- 998 W Tree Dr
Collierville, TN 38017-1329 - Phone
- (901) 850-5978
- NPI assigned
- Dec 27, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12348 | TN | Primary |
Addresses
Primary practice location
998 W Tree Dr
Collierville, TN 38017-1329
Mailing address
998 W Tree Dr
Collierville, TN 38017-1329
Phone (901) 850-5978
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12348 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324944000000",
"number": "1598034142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "998 W TREE DR",
"city": "COLLIERVILLE",
"state": "TN",
"postal_code": "380171329",
"telephone_number": "901-850-5978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "998 W TREE DR",
"city": "COLLIERVILLE",
"state": "TN",
"postal_code": "380171329",
"telephone_number": "901-850-5978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "IRA",
"middle_name": "DEAN",
"credential": "P.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-27",
"last_updated": "2011-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "12348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collierville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.